EP2777528B1 - Appareil pour procédures endoscopiques - Google Patents

Appareil pour procédures endoscopiques Download PDF

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Publication number
EP2777528B1
EP2777528B1 EP14159056.2A EP14159056A EP2777528B1 EP 2777528 B1 EP2777528 B1 EP 2777528B1 EP 14159056 A EP14159056 A EP 14159056A EP 2777528 B1 EP2777528 B1 EP 2777528B1
Authority
EP
European Patent Office
Prior art keywords
end effector
shaft assembly
lock
distal
bar
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Active
Application number
EP14159056.2A
Other languages
German (de)
English (en)
Other versions
EP2777528A2 (fr
EP2777528A3 (fr
Inventor
Justin Williams
Paul Scirica
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Covidien LP
Original Assignee
Covidien LP
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Filing date
Publication date
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Priority to EP16198094.1A priority Critical patent/EP3150146A1/fr
Publication of EP2777528A2 publication Critical patent/EP2777528A2/fr
Publication of EP2777528A3 publication Critical patent/EP2777528A3/fr
Application granted granted Critical
Publication of EP2777528B1 publication Critical patent/EP2777528B1/fr
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/005—Flexible endoscopes
    • A61B1/0051—Flexible endoscopes with controlled bending of insertion part
    • A61B1/0057—Constructional details of force transmission elements, e.g. control wires
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/2812—Surgical forceps with a single pivotal connection
    • A61B17/282—Jaws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
    • A61B2017/00398—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like using powered actuators, e.g. stepper motors, solenoids
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
    • A61B2017/00473—Distal part, e.g. tip or head
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00477—Coupling
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00681—Aspects not otherwise provided for
    • A61B2017/00734—Aspects not otherwise provided for battery operated
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07285—Stapler heads characterised by its cutter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2901—Details of shaft
    • A61B2017/2902—Details of shaft characterized by features of the actuating rod
    • A61B2017/2903—Details of shaft characterized by features of the actuating rod transferring rotary motion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2901—Details of shaft
    • A61B2017/2908—Multiple segments connected by articulations
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B17/2909—Handles
    • A61B2017/2925—Pistol grips
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft

Definitions

  • the present disclosure relates to surgical apparatus, devices and/or systems for performing endoscopic surgical procedures and methods of use thereof. More specifically, the present disclosure relates to electromechanical, hand-held surgical apparatus, devices and/or systems configured for use with removable disposable loading units and/or single use loading units for clamping, cutting and/or stapling tissue.
  • the electromechanical surgical devices include a handle assembly, which is reusable, and disposable loading units and/or single use loading units or the like that are selectively connected to the handle assembly prior to use and then disconnected from the handle assembly following use in order to be disposed of or in some instances sterilized for re-use.
  • electromechanical surgical devices are relatively expensive to manufacture, purchase and/or operate. There is a constant desire by manufactures and end users to develop electromechanical surgical devices that are relatively inexpensive to manufacture, purchase and/or operate yet still provide a large degree of operability.
  • the two part form of claim 1 is based on US 6443973 B1 .
  • the present disclosure relates to electromechanical, hand-held surgical apparatus, devices and/or systems configured for use with removable disposable loading units and/or single use loading units for clamping, cutting and/or stapling tissue.
  • an electromechanical surgical device includes an end effector configured to perform at least one function.
  • the end effector includes a rotatable drive screw having a coupling member at a proximal end thereof; and a flexible drive cable rotatably supported therein and extending therefrom, wherein the flexible drive cable receives rotational forces and transmits said rotational forces to the drive screw to actuate the end effector.
  • the electromechanical surgical device includes a shaft assembly.
  • the shaft assembly includes a proximal neck housing supported at a distal end of the outer tube; and a distal neck housing pivotally connected to the proximal neck housing, wherein a distal end of the distal neck housing is configured and adapted for operative connection with the end effector.
  • the flexible drive cable extends through the proximal neck housing and the distal neck housing.
  • the shaft assembly may include a coupling lug extending distally from the distal neck housing.
  • the coupling lug may be located substantially along a central longitudinal axis of the shaft assembly.
  • the end effector may define a central opening formed in a proximal surface thereof.
  • the central opening of the end effector may be configured and dimensioned to receive the coupling lug of the shaft assembly when the end effector is connected to the shaft assembly.
  • the end effector may include a lock actuator having at least a first position and a second position. In use, when the lock actuator is in the first position the coupling lug of the shaft assembly may be insertable into the central opening of the end effector upon a connection of the end effector to the shaft assembly.
  • the coupling lug of the shaft assembly may be prevented from insertion into the central opening of the end effector.
  • a disposition of the lock actuator to the second position may secure the end effector to the shaft assembly to inhibit disconnection of the end effector from the shaft assembly.
  • the end effector may include a lock bar operatively engageable by the lock actuator.
  • the lock bar may include a first position in which the lock bar does not extend across the central opening of the end effector; and a second position in which the lock bar at least partially extends across the central opening of the end effector.
  • the lock actuator may urge the lock bar to the second position when the lock actuator is in the second condition.
  • the coupling lug may define an outer annular race therearound. In use, when the lock bar is in the second position, and when the end effector is coupled to the shaft assembly, the lock bar may at least partially enter the annular race of the coupling lug.
  • the lock actuator may be biased to the second position or the lock bar may be biased to the first position.
  • the lock actuator may include an intermediate position between the first position and the second position thereof.
  • an angled camming surface of the lock actuator may be in contact with the lock bar such that the lock bar is disposed at an intermediate position between the first position and the second position thereof.
  • the coupling lug of the end effector may exert a force on the lock bar to urge the lock bar to the second position and the lock actuator to the first position.
  • the shaft assembly may define at least a pair of distally oriented notches formed in a distal end thereof.
  • the pair of notches may be radially offset by about 90° relative to one another.
  • the end effector may be rotated relative to the shaft assembly to axially align the lock actuator with one of the pair of notches to fix a rotational orientation of the end effector relative to the shaft assembly when the lock actuator is in the second position.
  • the end effector may be arranged to be manually rotated relative to the shaft assembly.
  • the shaft assembly may further include an articulation bar at least partially slidably supported in the distal neck housing.
  • the articulation bar may include a distal end; and a proximal end operatively connected to a rotatable drive shaft; wherein the articulation bar is off set a radial distance from the central longitudinal axis of the shaft assembly.
  • the shaft assembly may further include an articulation link having a proximal end pivotally connected to the distal end of the articulation bar, and a distal end pivotally connected to the distal neck housing.
  • actuation of the rotatable drive shaft of the electromechanical surgical device that is connected to the articulation bar may cause the articulation bar to axially translate.
  • axial translation of the articulation bar may cause the distal neck housing to pivot off axis relative to the proximal neck housing.
  • the shaft assembly may include a coil spring extending between and across the distal neck housing and the proximal neck housing.
  • the flexible drive cable may be sheathed in the coil spring.
  • At least the distal end of the flexible drive cable may be offset a radial distance from a central longitudinal axis of the shaft assembly.
  • an end effector for performing a surgical function and being connectable to an electromechanical power source.
  • the end effector includes an upper jaw and a lower jaw, at least one of the upper jaw and the lower jaw being movable in relation to the other of the upper jaw and the lower jaw, wherein the lower jaw of the end effector is configured to selectively receive a cartridge assembly; a drive beam slidably supported in the lower jaw and being translatable through each of the upper jaw and the lower jaw to move the lower jaw relative to the upper; a cartridge assembly configured for loading into the lower jaw, the cartridge assembly including an actuation sled slidably supported therein and being configured to expel at least a portion of a plurality of staples loaded in the cartridge assembly upon a distal movement of the actuation sled from a proximal-most position; a drive screw rotatably supported in the lower jaw, wherein the drive beam is threadably supported on the drive screw, whereby rotation of the drive screw results in axial translation of the
  • the lock bar includes a first position in which the lock bar does not extend across the opening of the proximal coupling hub; and a second position in which the lock bar at least partially extends across the opening of the proximal coupling hub.
  • the lock bar when the lock actuator is in the first position the lock bar may be in the first position, and, wherein when the lock actuator is in the second position the lock bar is engaged by the lock actuator and urged by the lock actuator to the second position.
  • either the lock actuator may be biased to the second position or the lock bar may be biased to the first position.
  • the lock actuator may include an intermediate position between the first position and the second position thereof. In use, when in the intermediate position, an angled camming surface of the lock actuator may be in contact with the lock bar such that the lock bar is disposed at an intermediate position between the first position and the second position thereof.
  • the end effector may further comprises a flexible drive cable rotatably supported therein and extending therefrom the coupling socket of the drive screw, wherein the flexible drive cable receives rotational forces and transmits said rotational forces to the drive screw to actuate the end effector.
  • an adapter shaft assembly for selectively interconnecting an end effector and an electromechanical power source.
  • the adapter shaft assembly includes an adapter housing configured and adapted for selective connection to at least one rotatable drive shaft of the electromechanical power source; an outer tube having a proximal end supported by the adapter housing and a distal end configured and adapted for operative connection with the end effector; and at least one force transmitting assembly for interconnecting a respective one of the at least one rotatable drive shaft of the electromechanical power source and at least one rotation receiving member supported in the end effector.
  • the at least one force transmitting assembly includes a flexible drive cable extending from the end effector, the flexible drive cable having a first end that is connected to a rotatable drive shaft that is connected to the at least one rotatable drive shaft of the electromechanical power source and a second end that is connectable to the at least one rotation receiving member of the end effector, wherein the at least one force transmitting assembly transmits a rotation of the rotatable drive shaft of the electromechanical power source to the at least one rotation receiving member of the end effector.
  • the adapter shaft assembly may further comprise a proximal neck housing supported at a distal end of the outer tube; and a distal neck housing pivotally connected to the proximal neck housing, wherein a distal end of the distal neck housing is configured and adapted for operative connection with the end effector.
  • the flexible drive cable may extend at least through the proximal neck housing and the distal neck housing when the end effector is connected to the shaft assembly.
  • the flexible drive cable may be offset a radial distance from a central longitudinal axis of the shaft assembly when the end effector is connected to the shaft assembly.
  • the adapter shaft assembly may further comprise a coupling lug extending distally from the distal neck housing.
  • the coupling lug may be located substantially along a central longitudinal axis of the shaft assembly.
  • the coupling lug may define an outer annular race therearound.
  • the distal neck housing may define at least a pair of distally oriented notches formed in a distal end thereof.
  • the pair of notches may be radially offset by about 90° relative to one another.
  • the end effector may be rotated relative to the shaft assembly to axially align a lock actuator of the end effector with one of the pair of notches to fix a rotational orientation of the end effector relative to the shaft assembly when the lock actuator is in a locking position projecting from the end effector.
  • the adapter shaft assembly may further comprise an articulation bar at least partially slidably supported in the distal neck housing.
  • the articulation bar includes a distal end; and a proximal end operatively connected to a rotatable drive shaft; wherein the articulation bar is off set a radial distance from the central longitudinal axis of the shaft assembly.
  • the adapter assembly may further comprise an articulation link having a proximal end pivotally connected to the distal end of the articulation bar, and a distal end pivotally connected to the distal neck housing.
  • actuation of the at least one rotatable drive shaft of the electromechanical power source that is connected to the articulation bar may cause the articulation bar to axially translate.
  • axial translation of the articulation bar may cause the distal neck housing to pivot off axis relative to the proximal neck housing.
  • the shaft assembly may include a coil spring, and wherein, when the end effector is connected to the shaft assembly, the flexible drive cable may be sheathed in the coil spring.
  • an end effector for performing a surgical function and being connectable to an electromechanical power source.
  • the end effector comprises an upper jaw and a lower jaw, at least one of the upper jaw and the lower jaw being movable in relation to the other of the upper jaw and the lower jaw, wherein the lower jaw of the end effector is configured to selectively receive a cartridge assembly; a drive beam slidably supported in the lower jaw and being translatable through each of the upper jaw and the lower jaw to move the lower jaw relative to the upper; a drive screw rotatably supported in the lower jaw, wherein the drive beam is threadably supported on the drive screw, whereby rotation of the drive screw results in axial translation of the drive beam, wherein the drive screw defines a proximal coupling socket; and a flexible drive cable having a first end that is connectable to a rotatable drive shaft that is connected to at least one rotatable drive shaft of an electromechanical power source, and a second end that is connected to the proximal coupling socket
  • the end effector may further comprise a cartridge assembly configured for loading into the lower jaw.
  • the cartridge assembly may include an actuation sled slidably supported therein and being configured to expel at least a portion of a plurality of staples loaded in the cartridge assembly upon a distal movement of the actuation sled from a proximal-most position.
  • distal refers to that portion of the electromechanical surgical system, apparatus and/or device, or component thereof, that are farther from the user
  • proximal refers to that portion of the electromechanical surgical system, apparatus and/or device, or component thereof, that are closer to the user.
  • Electromechanical surgical system 10 includes a surgical apparatus or device in the form of an electromechanical, hand-held, powered surgical instrument 100 that is configured for selective attachment with a plurality of different end effectors 400, via an adapter or shaft assembly 200, that is configured for actuation and manipulation by the electromechanical, hand-held, powered surgical instrument 100.
  • surgical instrument 100 is configured for selective connection with shaft assembly 200, and, in turn, shaft assembly 200 is configured for selective connection with any one of a plurality of different end effectors 400.
  • Other configurations are contemplated, such as, for example, an end effector attached to a shaft that is not removable, a remote power source and/or motor, and configurations including integral or remote computerized control.
  • the instrument 100 may include one or more motors powered by a battery, generator, or electrical power socket.
  • surgical instrument 100 includes a handle housing 102 having a lower housing portion 104, an intermediate housing portion 106 extending from and/or supported on lower housing portion 104, and an upper housing portion 108 extending from and/or supported on intermediate housing portion 106.
  • Handle housing 102 defines a cavity therein in which a circuit board or controller 150 and a drive mechanism 160 are situated.
  • Drive mechanism 160 may include a first motor 164 used to select a rotatable drive member of surgical instrument 100, and a second motor 166 used to drive each rotatable drive member of surgical instrument 100.
  • Circuit board 150 is configured to control the various operations of surgical instrument 100.
  • handle housing 102 provides a housing in which a rechargeable battery 156, is removably situated.
  • Battery 156 is configured to supply power to any of the electrical components of surgical instrument 100. While a battery 156 is shown and contemplated, any known power source may be used, such as, for example a power cord or the like.
  • Upper housing portion 108 of handle housing 102 defines a nose or connecting portion 108a configured to accept a corresponding shaft coupling assembly 214 of transmission housing 212 of shaft assembly 200.
  • connecting portion 108a of upper housing portion 108 of surgical instrument 100 has a cylindrical recess 108b that receives shaft coupling assembly 214 of transmission housing 212 of shaft assembly 200 when shaft assembly 200 is mated to surgical instrument 100.
  • Connecting portion 108a houses three rotatable drive connectors 118, 120, 122, each independently actuatable and rotatable by the drive mechanism (not shown) housed within handle housing 102.
  • Upper housing portion 108 of handle housing 102 provides a housing in which the drive mechanism (not shown) is situated.
  • the drive mechanism is configured to drive shafts and/or gear components in order to perform the various operations of surgical instrument 100.
  • the drive mechanism is configured to drive shafts and/or gear components in order to selectively move end effector 400 relative to shaft assembly 200; to rotate anvil assembly 200 and/or end effector 400, about a longitudinal axis "X" (see FIGS. 1 and 2 ), relative to handle housing 102; to move an upper jaw or anvil assembly 442 of end effector 400 relative to a lower jaw or cartridge assembly 432 of end effector 400, and/or to fire a stapling and cutting cartridge within cartridge assembly 432 of end effector 400.
  • each rotatable drive connector 118, 120, 122 of surgical instrument 100 couples with a corresponding rotatable connector 218, 222 of shaft assembly 200 (a corresponding rotatable connector of shaft assembly 200 for coupling with rotatable drive connector 120 not being shown).
  • the interface between corresponding first drive connector 118 and first connector 218, the interface between corresponding second drive connector 120 and second connector (not shown) of shaft assembly 200, and the interface between corresponding third drive connector 122 and third connector 222 are keyed such that rotation of each of drive connectors 118, 120, 122 of surgical instrument 100 causes a corresponding rotation of the corresponding first connector 218, second connector (not shown), and third connector 222 of shaft assembly 200.
  • the second drive connector (not shown) of surgical instrument 100 is used to transmit rotation from surgical instrument 100 to shaft assembly 200. It is contemplated that shaft assembly 200 may include a connector for receiving a rotation from second drive connector 120 of surgical instrument 100 for performing the rotation function.
  • drive connector 120 can be blocked by a computer program that is provided in one or more memory devices included in the controller of the instrument 100.
  • drive connector 120 can rotate freely.
  • drive connectors 118, 120, 122 of surgical instrument 100 with connectors 218, 222 (and the second drive connector, not shown) of shaft assembly 200 allows rotational forces to be independently transmitted via each of the respective connector interfaces.
  • the drive connectors 118, 120 122 of surgical instrument 100 are configured to be independently rotated by the drive mechanism.
  • a function selection module (not shown) of the drive mechanism selects which drive connector or connectors 118, 120, 122 of surgical instrument 100 is to be driven by an input drive component (not shown) of the drive mechanism.
  • an actuator for each of the drive connectors 118, 120, 122 can be provided on the surgical instrument 100.
  • each of drive connectors 118, 120, 122 of surgical instrument 100 has a keyed and/or substantially non-rotatable interface with respective first connector 218, second connector (not shown) and third connector 222 of shaft assembly 200, when shaft assembly 200 is coupled to surgical instrument 100, rotational force(s) are selectively transferred from the drive mechanism of surgical instrument 100 to shaft assembly 200, and on to end effector 400, as will be discussed in greater detail below.
  • the selective rotation of drive connector(s) 118, 120 and/or 122 of surgical instrument 100 allows surgical instrument 100 to selectively actuate different functions of end effector 400.
  • selective and independent rotation of first drive connector 118 of surgical instrument 100 corresponds to the selective and independent opening and closing of end effector 400, and driving of a stapling/cutting component of end effector 400.
  • the selective and independent rotation of second drive connector 120 of surgical device 100 corresponds to the selective and independent articulation of tool assembly 304 of end effector 300 transverse to longitudinal axis "X" (see FIG. 4 ).
  • the selective and independent rotation of third drive connector 122 of surgical instrument 100 corresponds to the selective and independent rotation of end effector 400 about longitudinal axis "X" (see FIG.
  • the opening and closing of the end effector 400 and the driving of the stapling and/or cutting component of the end effector 400 can be separately driven by two separate drive shafts and drive connectors.
  • the drive mechanism may include a selector gearbox assembly (not shown); a function selection module (not shown), located proximal to the selector gearbox assembly, that functions to selectively move gear elements within the selector gearbox assembly into engagement with a second motor (not shown).
  • the drive mechanism may be configured to selectively drive one of drive connectors 118, 120, 122 of surgical instrument 100, at a given time.
  • more than one motor can be provided in the surgical instrument 100 to, for example separately drive the drive shafts and drive connectors.
  • handle housing 102 supports a pair of finger-actuated control buttons 124, 126 and/or rocker device(s) 130 (only one rocker device being shown).
  • Each one of the control buttons 124, 126 and rocker device(s) 130 includes a respective magnet (not shown) that is moved by the actuation of an operator.
  • Shaft assembly 200 is configured to communicate the rotational forces of first, second and third rotatable drive connectors 118, 120 and 122 of surgical instrument 100 to end effector 400. As mentioned above, shaft assembly 200 is configured for selective connection to surgical instrument 100.
  • shaft assembly 200 includes an elongate, substantially rigid, tubular body 210 having a proximal end 210a and a distal end 210b; a transmission housing 212 connected to proximal end 210a of tubular body 210 and being configured for selective connection to surgical instrument 100; and an articulating neck assembly 230 connected to distal end 210b of elongate body portion 210.
  • Transmission housing 212 is configured to house a pair of gear train systems therein for varying a speed/force of rotation (e.g., increase or decrease) of first and/or second rotatable drive connectors 118 and/or 122 of surgical instrument 100 before transmission of such rotational speed/force to end effector 400.
  • a speed/force of rotation e.g., increase or decrease
  • Transmission housing 212 of shaft assembly 200 is configured and adapted to connect to connecting portion 108a of upper housing portion 108 of surgical instrument 100. As seen in FIGS. 2 and 3 , transmission housing 212 of shaft assembly 200 includes a shaft coupling assembly 214 supported at a proximal end thereof.
  • Shaft assembly 200 may include a first gear train system and a second gear train system, each disposed within transmission housing 212 and tubular body 210.
  • Each gear train system is configured and adapted to vary a speed/force of rotation (e.g., increase or decrease) of first rotatable drive connector 118 of surgical instrument 100 before transmission of such rotational speed/force to end effector 400.
  • shaft assembly 200 functions to transmit operative forces from surgical instrument 100 to end effector 400 in order to operate, actuate and/or fire end effector 400. Additionally, in accordance with an embodiment of the present disclosure, shaft assembly 200, including the second gear system, functions to transmit operative forces from surgical instrument 100 to end effector 400 in order rotate shaft assembly 200 and/or end effector 400 relative to surgical instrument 100.
  • elongate body portion 210 of shaft assembly 200 includes a support frame 211 defining at least two longitudinally extending channels through body portion 210.
  • the channels are configured and dimensioned to rotatably receive and support at least a first output drive shaft or bar 238 (i.e., an articulation bar) of the first gear system, and a second output drive shaft or bar 246a.
  • first output drive shaft or bar 238, and second output drive shaft or bar 246a are elongate and sufficiently rigid to transmit axial or rotational forces from transmission housing 212 to articulating neck assembly 230.
  • Articulating neck assembly 230 includes a proximal neck housing 232; and a distal neck housing 236 pivotally connected to and extending distally from proximal neck housing 232 by a pivot pin 234.
  • Pivot pin 234 defines a pivot axis "P" (see FIG. 6 ) that is oriented orthogonal to the longitudinal axis "X" and extends through the longitudinal axis "X”.
  • Articulation neck assembly 230 receives a distal end of output drive shaft or articulation bar 238.
  • Articulation bar 238 may include a threaded proximal end that is in threaded engagement with a distal end of an internally threaded nut (not shown).
  • the threaded nut may be rotatably supported and axially fixed within a pocket (not shown) formed in transmission housing 212.
  • a proximal end of the threaded nut is keyed to a distal end of first rotatable connector 218 of shaft assembly 200.
  • Articulation bar 238 includes a distal end 238b pivotally connected to a proximal end 240a of an articulation link 240.
  • a distal end 240b of articulation link 240 is pivotally connected to distal neck housing 236.
  • Proximal neck housing 232 defines a chamfered distal surface 232a
  • distal neck housing 236 defines a chamfered proximal surface 236a.
  • chamfered surfaces 232a, 236a are in juxtaposed relation to one another.
  • chamfered surfaces 232a, 236a of proximal neck housing 232 and distal neck housing 236 are approximated toward one another.
  • each chamfered surface 232a, 236a is angled at about 45° relative to the longitudinal axis "X".
  • chamfered surface 232a of proximal neck housing 232 is angled at about (-)45° relative to the longitudinal axis "X"
  • chamfered surface 236a of distal neck housing 236 is angled at about (+)45° relative to the longitudinal axis "X”.
  • end effector 400 is oriented at about 90° relative to the longitudinal axis "X”.
  • end effector 400 may be oriented at any angular orientation from about 0° to about 90° relative to the longitudinal axis "X", as needed or desired, such as, for example, about 45°, as seen in FIGS. 21 and 22 .
  • distal neck housing 236 is pivotable in a single direction relative to proximal neck housing 232.
  • articulating neck assembly 230 further includes a distal connection hub 250 rotatably supported and/or coupled in a distal end of distal neck housing 236.
  • Connection hub 250 supports a coupling lug 250a projecting distally therefrom along a centerline of connection hub 250.
  • Coupling lug 250a includes a head 250b defining an angled distal surface 250c, in the form of a cone or the like, and an annular race or groove 250d defined in an outer annular surface thereof.
  • Shaft assembly 200 is configured to accommodate a flexible drive cable 242 and a cable coupler 243 extending from end effector 400, as will be described in greater detail below.
  • Shaft assembly 200 includes a reinforcing coil spring 244 configured to accommodate and surround flexible drive cable 242 of end effector 400, when end effector 400 is connected to shaft assembly 200.
  • reinforcing coil spring 244 is constrained at a proximal end and a distal end thereof, and is installed under compression.
  • Reinforcing coil spring 244 functions to help keep flexible drive cable 242 from kinking during articulation of end effector 400.
  • Reinforcing coil spring 244 also functions to help keep flexible drive cable 242 from failing due to unwinding and/or "pig tailing" during rotation thereof.
  • distal neck housing 236 defines a first annular notch 236b extending distally therefrom, and a second annular notch 236c extending distally therefrom, wherein the first annular notch 236b and the second annular notch 236c are disposed at approximately 90° relative to one another. It is contemplated that any number of notches may be provided and may be disposed ay any desired angle relative to one another.
  • cable coupler 243 of flexible drive cable 242 of end effector 400 is configured for selective connection to a distal end of first output drive shaft 246a of the first gear system of shaft assembly 200. It is contemplated that cable coupler 243 is configured for non-rotatable connection to first output drive shaft 246a or second output drive shaft 258a.
  • flexible drive cable 242, including cable coupler 243 form a part of end effector 400, each time a new end effector 400 is coupled to shaft assembly 200 a new flexible drive cable 242 (and cable coupler 243) is also loaded into of coupled to shaft assembly 200.
  • proximal neck housing 232 and distal neck housing 236 In order to properly load or connect end effector 400 (including flexible drive cable 242 and cable coupler 243) to shaft assembly 200, in accordance with the present disclosure, proximal neck housing 232 and distal neck housing 236 must be in the non-articulated position relative to one another. With proximal neck housing 232 and distal neck housing 236 in the non-articulate position relative to one another, flexible drive cable 242 (and cable coupler 243) may be threaded or fed into or withdrawn from shaft assembly 200.
  • End effector 400 is constructed substantially in accordance with end effector 400 disclosed in U.S. Provisional Patent Application Serial No. 61/659,116, filed on June 13, 2012 , entitled “Apparatus for Endoscopic Procedures", and thus will only be discussed in detail herein to the extent necessary to describe differences in construction and operation thereof.
  • End effector 400 may be configured and adapted to apply a plurality of linear rows of fasteners, which in embodiments may be of various sizes, and which, in certain embodiments may have various lengths or rows, e.g., about 30, 45 and 60 mm in length.
  • end effector 400 includes a mounting portion 420 having a coupling member 422 configured for selective connection to distal neck housing 236 of shaft assembly 200.
  • End effector 400 further includes a jaw assembly 430 connected to and extending distally from mounting portion 420.
  • jaw assembly 430 includes a lower jaw 432 pivotally connected to mounting portion 420 and being configured to selectively support a cartridge assembly therein, and an upper jaw 442 secured to mounting portion 420 and being movable, relative to lower jaw 432, between approximated and spaced apart positions.
  • Coupling member 422 is substantially cylindrical and includes a rear or proximal wall 422a defining a central opening 422b therein, and a passage 422c therein.
  • Central opening 422b is configured and dimensioned to receive head 250b of lug 250a therein.
  • Passage 422c is configured and dimensioned to axially align with or create a pathway to coupling socket 464a of lead or drive screw 464 of end effector 400, as will be discussed in greater detail below. In this manner, when end effector 400 is connected to shaft assembly 200, distal end 242b of flexible drive cable 242 is guided into coupling socket 464a of lead or drive screw 464 of end effector 400 to establish a connection therewith, as will be discussed in greater detail below.
  • Coupling member 422 of end effector 400 supports a lock mechanism 470 for selectively securing end effector 400 to shaft assembly 200.
  • Lock mechanism 470 includes a lock bar 472 slidably supported in coupling member 422 so as to slide in a plane transverse or orthogonal to central opening 422b.
  • Lock mechanism 470 includes at least one biasing member for biasing lock bar 472 to an unlocked position wherein lock bar 472 does not engage or is not disposed within annular race or groove 250c of lug 250a, as will be discussed in greater detail below.
  • lock mechanism 470 includes a pair of biasing members 474a, 474b disposed at opposed ends of lock bar 472 and extending substantially orthogonal to lock bar 472, and being disposed in a plane of movement of lock bar 472.
  • Biasing members 474a, 474b are spaced a distance from one another which is less than a diameter or transverse cross-sectional dimension of head 250b of lug 250a, and/or less that a diameter of central opening 422b of coupling member 422.
  • Lock bar 472 includes an arcuate or substantially U-shaped surface 472a oriented toward central opening 422b of coupling member 422.
  • Lock mechanism 470 further includes a lock actuator 476 slidably supported in mounting portion 420 of end effector 400.
  • Lock actuator 476 is in the form of a lock button or slide which is slidable in distal and proximal axial directions.
  • Lock actuator 476 defines a finger engaging surface 476a exposed along an outer surface thereof.
  • Lock actuator 476 includes a finger or nose 476b extending proximally from an angled or ramped proximal surface 476c thereof.
  • Lock mechanism 470 includes a biasing member 478 acting on lock actuator 476 for biasing lock actuator 476 to a proximal position.
  • Lock actuator is slidable between a distal-most position, a proximal-most position, and an intermediate position upon actuation by an end user, or automatically.
  • lock actuator 476 includes a first or distal-most position wherein biasing member 478 is compressed and/or biased, and wherein lock bar 472 is in an unactuated condition.
  • lock mechanism 470 is in an unlocked condition, wherein lock bar 472 is moved, by biasing member 474a, 474b, away from central opening 422b of coupling member 422, thus clearing central opening 422b for reception of head 250b of lug 250a of shaft assembly 200.
  • lock bar 472 may rest against nose 476b of lock actuator 476.
  • lock actuator 476 includes a second or proximal-most position wherein biasing member 478 is substantially uncompressed and/or unbiased, and wherein lock bar 472 is in an actuated condition.
  • lock mechanism 470 is in a locked condition, wherein lock bar 472 is moved, cammed or urged, by angled or ramped proximal surface 476c of lock actuator 476, toward central opening 422b of coupling member 422, thus at least partially obstructing central opening 422b and entering annular race or groove 250d of lug 250a of shaft assembly 200 (when end effector 400 and shaft assembly 200 are connected to one another).
  • lock bar 472 may rest against an inner surface 476d of lock actuator 476 which is located distal of angled or ramped proximal surface 476c of lock actuator 476.
  • lock actuator 476 includes a third or intermediate position wherein biasing member 478 is partially compressed and/or biased, and wherein lock bar 472 is disposed against or rests against angled or ramped proximal surface 476c of lock actuator 476.
  • lock mechanism 470 When lock actuator 476 is in the intermediate position, lock mechanism 470 is in an automatic unlocked condition, wherein lock bar 472 is capable of moving, camming or urging, lock actuator 476 to the unlocked condition by exerting a force on angled or ramped proximal surface 476c of lock actuator 476, in a direction away from central opening 422b of coupling member 422, such as by head portion 250b of lug 250a acting on lock bar 472 if/when end effector 400 is axially separated from or moved apart from shaft assembly 200 (such as when end effector 400 and shaft assembly 200 are to be disconnected from one another).
  • end effector 400 may be properly connected to shaft assembly 200 in a first orientation or a second orientation (rotated approximately 90° relative to the first orientation, or any other desirable angle).
  • the first and second orientations correspond to the location of the first annular notch 236b and the second annular notch 236c provided in distal neck housing 236 of shaft assembly 200, as described above.
  • coupling member 422 of end effector 400 is inserted into distal neck housing 236 of shaft assembly 200, with lock actuator 476 being held (either manually or do to the contact of nose 476b of lock actuator 476 contacting a surface of distal neck housing 236 of shaft assembly 200) in the distal-most position (such that head 250b of lug 250a of shaft assembly 200 may be fully inserted into central opening 422b of coupling member 422 of end effector 400), end effector 400 is rotated relative to shaft assembly 200, along the longitudinal axis "X".
  • lock actuator 476 may be moved to the intermediate or proximal-most position, as described above, to selectively, fixedly secure end effector 400 to shaft assembly 200 in either the first orientation or the second orientation, wherein the orientations have been manually selected and set.
  • distal end 242b of flexible drive cable 242 is inserted into and/or coupled to coupling socket 464a of lead or drive screw 464 of end effector 400 such that rotation of flexible drive cable 242 of shaft assembly 200 results in rotation of lead or drive screw 400.
  • lower jaw 432 of jaw assembly 430 includes a drive screw 464 rotatably supported therein and extending substantially an entire length thereof.
  • Drive screw 464 includes a female coupling socket or member 464a (or other crimp/bonded connection) supported on a proximal end thereof and being configured for receipt of a distal end 242b of flexible drive cable 242.
  • end effector 400 includes a flexible drive cable 242 extending proximally therefrom.
  • flexible drive cable 242 includes a distal end 242b non-rotatably secured or connected to coupling socket 464a of drive screw 464 of end effector 400.
  • Flexible drive cable 242 includes a proximal end 242a that is non-rotatably coupled to a cable coupler 243 which is configured for selective non-rotatable connection to first output drive shaft 246a of the first gear system of shaft assembly 200.
  • Flexible drive cable 242 is fabricated from a torsionally stiff and flexible material, such as, for example, stainless steel wire strands spun together into a common cable.
  • end effector 400 include flexible drive cable 242, each time a new end effector 400 is connected to shaft assembly 200 a new flexible drive cable 242 is provided and also connected to shaft assembly 200.
  • flexible drive cable 242 is shown and described as being non-removably connected to coupling socket 464a of drive screw 464 of end effector 400, it is contemplated and within the scope of the present disclosure for distal end 242b of flexible drive cable 242 to be removably and non-rotatably connected to coupling socket 464a of drive screw 464 of end effector 400.
  • end effector 400 includes a drive beam 466 slidably supported in lower jaw 432 of jaw assembly 430 and threadably connected to the threads of drive screw 464.
  • Drive beam 466 includes a substantially I-shaped cross-sectional profile and is configured to approximate lower jaw 432 and upper jaw 442, and to axially displace an actuation sled 468 through lower jaw 432.
  • surgical instrument 100 and/or cartridge assembly 410 need not apply staples but rather may apply two part fasteners as is known in the art.
  • the length of the linear row of staples or fasteners may be modified to meet the requirements of a particular surgical procedure.
  • the length of the linear row of staples and/or fasteners within a staple cartridge assembly may be varied accordingly. Therefore, the above description should not be construed as limiting, but merely as exemplifications of preferred embodiments. Those skilled in the art will envision other modifications within the scope of the claims appended thereto.

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Claims (9)

  1. Dispositif chirurgical électromécanique (10), comprenant :
    un effecteur terminal (400) configuré pour effectuer au moins une fonction, l'effecteur terminal incluant :
    une vis d'entraînement rotative (464) ayant un élément d'accouplement (422) au niveau d'une extrémité proximale de celle-ci ;
    une ouverture (422b) formée dans une surface proximale de l'effecteur terminal ; et
    un câble de transmission par élément flexible (242) supporté en rotation en son sein et s'étendant à partir de là, dans lequel le câble de transmission par élément flexible reçoit des forces de rotation et transmet lesdites forces de rotation à la vis d'entraînement pour actionner l'effecteur terminal ; et
    caractérisé par un ensemble formant arbre (200) incluant :
    un logement de col proximal (232) supporté au niveau d'une extrémité distale du tube extérieur :
    un logement de col distal (236) relié de manière pivotante au logement de col proximal, dans lequel une extrémité distale du logement de col distal est configurée et conçue pour une connexion opérationnelle avec l'effecteur terminal (400) ;
    dans lequel, lorsque l'effecteur terminal est relié à l'ensemble formant arbre (200), le câble de transmission par élément flexible (242) s'étend à travers le logement de col proximal (232) et le logement de col distal (236) ;
    un tenon d'accouplement (250a) s'étendant de façon distale à partir du logement de col distal, le tenon d'accouplement étant configuré pour être inséré dans l'ouverture (422b) de l'effecteur terminal lorsque l'effecteur terminal est relié à l'ensemble formant arbre ;
    et un dispositif d'actionnement de verrou (476) disposé sur l'effecteur terminal, le dispositif d'actionnement de verrou ayant au moins une première position et une seconde position, dans lequel lorsque le dispositif d'actionnement de verrou est dans la première position le tenon d'accouplement (250a) de l'ensemble formant arbre peut être inséré dans l'ouverture (422b) de l'effecteur terminal lors d'une connexion de l'effecteur terminal à l'ensemble formant arbre, et lorsque le dispositif d'actionnement de verrou est dans la seconde position le tenon d'accouplement (250a) de l'ensemble formant arbre est empêché d'être inséré dans ou d'être enlevé de l'ouverture (422b) de l'effecteur terminal.
  2. Dispositif chirurgical électromécanique selon la revendication 1, dans lequel le tenon d'accouplement (250a) est situé sensiblement le long d'un axe longitudinal central de l'ensemble formant arbre (200).
  3. Dispositif chirurgical électromécanique selon la revendication 1, dans lequel l'effecteur terminal (400) inclut une barre de verrou (472) pouvant être mise en prise de manière opérationnelle par le dispositif d'actionnement de verrou (476), dans lequel la barre de verrou inclut :
    une première position dans laquelle la barre de verrou ne s'étend pas d'un bout à l'autre de l'ouverture centrale de l'effecteur terminal ; et
    une seconde position dans laquelle la barre de verrou s'étend au moins partiellement d'un bout à l'autre de l'ouverture centrale de l'effecteur terminal.
  4. Dispositif chirurgical électromécanique selon la revendication 3, dans lequel le dispositif d'actionnement de verrou (476) pousse la barre de verrou (472) jusqu'à la seconde position lorsque le dispositif d'actionnement de verrou est dans le second état, de préférence dans lequel le tenon d'accouplement (250a) définit un chemin de roulement annulaire extérieur (250d) autour de ce dernier et dans lequel, lorsque la barre de verrou est dans la seconde position, et quand l'effecteur terminal est accouplé à l'ensemble formant arbre, la barre de verrou pénètre au moins partiellement dans le chemin de roulement annulaire du tenon d'accouplement.
  5. Dispositif chirurgical électromécanique selon la revendication 3 ou la revendication 4, dans lequel au moins un du dispositif d'actionnement de verrou (476) est sollicité vers la seconde position, et la barre de verrou (472) est sollicitée vers la première position.
  6. Dispositif chirurgical électromécanique selon n'importe laquelle des revendications 3 à 5, dans lequel le dispositif d'actionnement de verrou (476) inclut une position intermédiaire entre la première position et la seconde position de celui-ci,
    dans lequel dans la position intermédiaire, une surface inclinée servant de came (476c) du dispositif d'actionnement de verrou est en contact avec la barre de verrou (472) de sorte que la barre de verrou est disposée à une position intermédiaire entre la première position et la seconde position de celle-ci, de préférence dans lequel dans la position intermédiaire du dispositif d'actionnement de verrou, lors d'une séparation de l'effecteur terminal depuis l'ensemble formant arbre, le tenon d'accouplement (250a) de l'effecteur terminal exerce une force sur la barre de verrou pour pousser la barre de verrou jusqu'à la seconde position et le dispositif d'actionnement de verrou jusqu'à la première position.
  7. Dispositif chirurgical électromécanique selon la revendication 3, dans lequel l'ensemble formant arbre (200) définit au moins un couple d'encoches orientées de façon distale (236b, 236c) formées dans une extrémité distale de celui-ci, dans lequel les deux encoches sont décalées de façon radiale d'environ 90° l'une par rapport à l'autre, et dans lequel l'effecteur terminal (400) est tourné par rapport à l'ensemble formant arbre pour aligner de façon axiale le dispositif d'actionnement de verrou (476) sur une du couple d'encoches pour fixer une orientation en rotation de l'effecteur terminal par rapport à l'ensemble formant arbre lorsque le dispositif d'actionnement de verrou est dans la seconde position, de préférence dans lequel l'effecteur terminal est agencé pour être manuellement tourné par rapport à l'ensemble formant arbre.
  8. Dispositif chirurgical électromécanique selon n'importe quelle revendication précédente, dans lequel l'ensemble formant arbre (200) comprend en outre :
    une barre d'articulation (238) supportée au moins partiellement de manière coulissante dans le logement de cou distal (236), la barre d'articulation incluant :
    une extrémité distale (238b) ; et
    une extrémité proximale reliée de manière opérationnelle à un arbre d'entraînement rotatif (464); dans lequel la barre d'articulation est décalée d'une distance radiale par rapport à l'axe longitudinal central de l'ensemble formant arbre ; et
    une liaison d'articulation (240) ayant une extrémité proximale reliée de manière pivotante à l'extrémité distale de la barre d'articulation, et une extrémité distale reliée de manière pivotante au logement de col distal ;
    dans lequel l'actionnement de l'arbre d'entraînement rotatif du dispositif chirurgical électromécanique qui est relié à la barre d'articulation (238) provoque la translation axiale de la barre d'articulation ; et
    dans lequel la translation axiale de la barre d'articulation amène le logement de col distal à pivoter hors de l'axe par rapport au logement de col proximal (232).
  9. Dispositif chirurgical électromécanique selon n'importe quelle revendication précédente, dans lequel l'ensemble formant arbre (200) inclut un ressort hélicoïdal (244) s'étendant entre et d'un bout à l'autre du logement de col distal (236) et le logement de col proximal (232) et dans lequel, lorsque l'effecteur terminal est relié à l'ensemble formant arbre, le câble de transmission par élément flexible (242) est engainé dans le ressort hélicoïdal, et/ou dans lequel, lorsque l'effecteur terminal est relié à l'ensemble formant arbre, au moins l'extrémité distale du câble de transmission par élément flexible est décalée d'une distance radiale par rapport à un axe longitudinal central de l'ensemble formant arbre.
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AU2014200778B2 (en) 2017-08-31
JP2014176649A (ja) 2014-09-25
EP2777528A2 (fr) 2014-09-17
US10085752B2 (en) 2018-10-02
AU2014200778A1 (en) 2014-10-02
US9492189B2 (en) 2016-11-15
ES2612706T3 (es) 2017-05-18
EP2777528A3 (fr) 2014-10-15
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US20140276932A1 (en) 2014-09-18
CN104042271A (zh) 2014-09-17

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